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Sakra World Hospital and Bangalore Baptist Hospital, Bangalore, India - Emma Pedlar, 2014

For my elective I joined the plastic surgery department at Sakra World Hospital, a multi-speciality corporate hospital in Bangalore, south India. My supervisor, Dr. Derick Mendonca, was an Indian surgeon who had completed his speciality training in the UK. He had been in Bangalore for two and a half years, together with his wife (a British dentist) and their 3 young children. During my stay they became my India family, as I lived nearby and ate most of my meals with them. Getting to know them all was one of the best parts of my elective, and I got to see what it takes to move your family halfway across the world, and the realities of life once you get there.

Sakra has a small plastic surgery team, of which I made up a third. However it was a busy department with a steady stream of trauma, reconstructive cases, diabetic and pressure ulcers and cosmetic cases. We operated all over the body, as the realm of plastic surgery extends from soft tissues including nerves and vasculature to speciality areas such as the hands and face. Plastic surgeons often work with other specialities such as neurosurgery, orthopaedics, cardiothoracics, diabetes and endocrinology and general surgery. There was never a dull moment, and no two days were the same.

My supervisor's area of particular interest was craniofacial surgery. I was given the opportunity to assist in these cases, including calvarial vault reconstruction and fronto-orbital advancement for craniosynostosis, mandibular distraction and maxillary advancement, and open reduction and internal fixation of facial fractures. I enjoyed this cases more than I expected and found it incredibly satisfying seeing the post operative results. These patients would look completely transformed, particularly the craniosynostosis children. I found it very moving to see how much off a difference the surgery made and I was a bit overwhelmed by the gratitude of some parents, one mother of even tried to kiss our feet. This operation is done infrequently in India and rarely well. Not only was it a privilege to be part of but I saw how valuable these skills were and how Derick had found an area of need in which he could serve the Indian people by treating.

I was given the opportunity to spend part of my elective in a mission setting at Bangalore Baptist Hospital, as my supervisor often went there to operate on leprosy cases. BBH has been serving the communities around Hebbal in North Bangalore for more than 40 years. It has seen massive transformation in the surrounding area, and increased from 40 beds to nearly 300. It is well equipped with ICU, PICU, theatres in which complex operations are regularly performed, A&E and many other specialities. They have a strong community outreach which I joined for a day in one of the slums. Many of the patients had diabetes and hypertension. It was almost like being in GP, minus all the resources and with more interesting smells! I happened to visit on the day when they were inaugurating a new dental chair and somehow I got included in the ribbon cutting ceremony. Ironically they gave out sweets and fizzy drinks whilst celebrating the arrival of the dental chair! At the hospital I spent time with the surgical team, seeing patients on the wards, in clinic and in theatre. I really liked the Christian ethos of the hospital, and went to the prayer and handover meetings in the morning. BBH places a strong emphasis on pastoral care and have a team which attend to the emotional and spiritual needs of the patients.

I especially enjoyed the leprosy cases I saw at BBH and having read about the life and work of Dr Paul Brand found really it exciting performing the operations he developed. We did tendon transfers for claw hands and feet, used a tendon sling to help correct lagophthalmos and I learnt about nasal reconstruction. I went to an International Church which was very welcoming and the bible teaching was excellent. It was not only a great way of meeting people, but there everyone is from different countries so I felt much less conspicuous! I felt very blessed by the friendships I made, and had several fun weekends visiting Mysore and Goa with some of the doctors from Sakra. I also feel like I properly embraced Indian culture, eating the food (my spice tolerance has definitely increased), wearing the clothes, using the public transport and even going to see my supervisor's children in their school play.

However my elective was not without challenges. At BBH I sometimes felt lost in a sea of medical students (once there were 14 Malaysian students and me on a ward round). I greatly appreciated having the whole of Sakra to myself to go and do whatever I pleased. The language was often a barrier, despite many people speaking English often conversations and consultations would occur in Hindi or Kannada. I found the private healthcare system quite frustrating, for example patients with injuries who we couldn't treat as they were too poor. Fortunately I saw how Dr. Derick would try and work around the system to try and make treatment affordable for patients. He even set up a fund to help really poor patients who needed large, expensive operations like those for craniosynostosis or a hypoplastic maxilla following a cleft palate repair. I certainly learnt to appreciate the NHS and not take it for granted. I think a lot of British people have no idea how fortunate they are in the UK.

India is a fascinating country to live in; a friend described it as life in HD. It is busy, noisy, smelly (jasmine, curry, cows and open sewers immediately jump to mind), colourful, hot (both food and temperature), vibrant, friendly and chaotic. I learnt that mission doesn't have to be in the middle of nowhere, and that sometimes medical missionaries need to be in developed settings in order to have the facilities to use their skills.

This elective would be ideal for someone with a keen interest in plastic surgery who wanted to get lots of hands on experience. Bangalore Baptist Hospital is also a great place for an elective in other specialities in a mission hospital setting. I stayed near Sakra, but there is guest accommodation at BBH. I had to pay a small fee to volunteer at BBH, but food and transport is very cheap. I only met one other elective student so nearly all of my friendships where with people who lived in Bangalore. It's quite a westernised city so home comforts are not that hard to find. However with the complete contrast of wealth and poverty side by side there is still a lot of need. I loved the 2 months I spent in Bangalore, it went by far too quickly and I quite happily could have stayed much longer.

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